Influence Of Injury Severity And Recovery Environment On Physical Activity And Function Following Lower-limb Amputation

Abstract

Restoration of physical function and physical activity (PA) is considered a vital therapeutic component in the short-term rehabilitation and long-term recovery of individuals with traumatic lower-limb amputation(s) (LLA). Unfortunately, evidence suggests an increased prevalence of physical inactivity and reduced functional status in this population. PURPOSE: To determine the impact of free-living environment (rehabilitation vs. home) on PA and function in UK military personnel following traumatic LLA, compared to active non-injured controls (CON). METHODS: Sixteen LLA (8 unilateral (UNI), 30±5yrs; 8 bilateral (BI), 29±3yrs), nearing the end of their clinical rehabilitation care pathway, attended one 4-week residential rehabilitation admission and one 6-week recovery block at home. Thirteen physically active, age-matched males (28±5yrs) represented CON. Estimated daily ambulatory PA energy expenditure (PAEE) was estimated from an accelerometer (Actigraph GT3X+), worn on the hip of the shortest residual limb in each environment, using validated population specific prediction algorithms. Six minute walk distance (6MWD) was recorded at baseline and 10 weeks (general population 6MWD norms is >459m). RESULTS: Whilst at home, mean PA counts.day-1 reduced by 17% (p=0.018) and 42% (p=0.001) in the UNI and BI group, respectively. UNI group demonstrated a similar capacity for PAEE to CON, both of which were greater (P<0.05) than BI (Table 1). No significant changes in 6MWD were demonstrated within groups (P>0.05), however, significant differences (P<0.05) were demonstrated between all groups at baseline (UNI, 574±66m; BI, 337±85m, CON, 705±32m). CONCLUSION: UNI group demonstrate a similar capacity for PA and function to active non-injured CON. To support and manage the long-term health and well-being of more severely injured BI LLA, future research should investigate strategies that promote regular engagement in PAEE, particularly when they return home.